Addresses non-covered dental services by prohibiting insurers from including in a contract or agreement with a dentist requirements to set fees or require approval fees for services not covered under a person's dental plan; prohibits medical expense indemnity corporations, dental expense indemnity corporations and health service corporations from including in a contract or agreement with a dentist requirements to set fees or require approval fees for services not covered under a person's dental plan.
STATE OF NEW YORK
________________________________________________________________________
5313
2025-2026 Regular Sessions
IN SENATE
February 20, 2025
___________
Introduced by Sens. BAILEY, GALLIVAN, GOUNARDES, HARCKHAM -- read twice
and ordered printed, and when printed to be committed to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to addressing non-covered
dental services
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 4224 of the insurance law is amended by adding a
2 new subsection (g) to read as follows:
3 (g)(1) Notwithstanding any other provision of this section, no insurer
4 authorized to do business in this state shall include a provision in a
5 contract or participating provider agreement with a dentist which
6 requires, directly or indirectly, that a participating dentist provide
7 services to an insured at a fee set by, or at a fee subject to the
8 approval of, the insurer unless the dental services are covered services
9 under the insured's dental plan.
10 (2) For purposes of this subsection, "covered services" shall mean
11 dental services for which reimbursement is available under an insured's
12 dental plan or for which a reimbursement would be available but for the
13 application of contractual limitations such as deductibles, copayments,
14 coinsurance, waiting periods, annual or lifetime maximums, frequency
15 limitations, alternative benefit payments, or any other limitation.
16 § 2. Subsection (s) of section 4303 of the insurance law, as added by
17 chapter 293 of the laws of 1992, is amended to read as follows:
18 [(s)](s-1)(1) Notwithstanding any provision of a contract issued by a
19 medical expense indemnity corporation, a dental expense indemnity corpo-
20 ration or health service corporation, every contract which provides
21 coverage for care provided through licensed health professionals who can
22 bill for services shall provide the same coverage and reimbursement for
23 such service provided pursuant to a clinical practice plan established
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD07721-01-5
S. 5313 2
1 pursuant to subdivision fourteen of section two hundred six of the
2 public health law.
3 (2) Notwithstanding any other provision of this section, no medical
4 expense indemnity corporation, dental expense indemnity corporation or
5 health service corporation authorized to do business in this state shall
6 include a provision in a contract or participating provider agreement
7 with a dentist which requires, directly or indirectly, that a partic-
8 ipating dentist provide services to an insured at a fee set by, or at a
9 fee subject to the approval of, the medical expense indemnity corpo-
10 ration, dental expense indemnity corporation or health service corpo-
11 ration unless the dental services are covered services under the
12 insured's dental plan.
13 (3) For purposes of this subsection, "covered services" shall mean
14 dental services for which reimbursement is available under an insured's
15 dental plan or for which a reimbursement would be available but for the
16 application of contractual limitations such as deductibles, copayments,
17 coinsurance, waiting periods, annual or lifetime maximums, frequency
18 limitations, alternative benefit payments, or any other limitation.
19 § 3. This act shall take effect January 1, 2027 and shall apply to all
20 insurance contracts issued or entered into on or after such date.
